Lung Cancer Staging - American Joint Committee on Cancer

A m e r i c a n
J o i n t
C o m m i t t e e
o n
C a n c e r
Lung Cancer Staging
7t h E D I T I O N
Definitions
Primary Tumor (T)
TX Primary tumor cannot be assessed, or tumor
proven by the presence of malignant cells
in sputum or bronchial washings but not
visualized by imaging or bronchoscopy
T0 No evidence of primary tumor
Tis Carcinoma in situ
T1 Tumor 3 cm or less in greatest dimension,
surrounded by lung or visceral pleura,
without bronchoscopic evidence of invasion
more proximal than the lobar bronchus
(for example, not in the main bronchus)1
T1a Tumor 2 cm or less in greatest dimension
T1b Tumor more than 2 cm but 3 cm
or less in greatest dimension
T2 Tumor more than 3 cm but 7 cm or less or
tumor with any of the following features (T2
tumors with these features are classified T2a
if 5 cm or less): involves main bronchus, 2 cm
or more distal to the carina; invades visceral
pleura (PL1 or PL2); associated with atelectasis
or obstructive pneumonitis that extends to the
hilar region but does not involve the entire lung
T2a Tumor more than 3 cm but 5 cm
or less in greatest dimension
T2b Tumor more than 5 cm but 7 cm
or less in greatest dimension
T3 Tumor more than 7 cm or one that directly
invades any of the following: parietal
pleural (PL3), chest wall (including superior
sulcus tumors), diaphragm, phrenic nerve,
mediastinal pleura, parietal pericardium; or
tumor in the main bronchus less than 2 cm
distal to the carina1 but without involvement
of the carina; or associated atelectasis or
obstructive pneumonitis of the entire lung or
separate tumor nodule(s) in the same lobe
T4 Tumor of any size that invades any of the
following: mediastinum, heart, great vessels,
trachea, recurrent laryngeal nerve, esophagus,
vertebral body, carina, separate tumor
nodule(s) in a different ipsilateral lobe
A N AT O M I C S TAG E / P R O G N O S T I C G R O U P S
Occult Carcinoma
Stage 0
Stage IA
Stage IB
Stage IIA
Stage IIB
Stage IIIA
Distant Metastasis (M)
M0 No distant metastasis
M1 Distant metastasis
M1a Separate tumor nodule(s) in a contralateral
lobe, tumor with pleural nodules or
malignant pleural (or pericardial) effusion2
M1b Distant metastasis (in extrathoracic organs)
Stage IIIB
Stage IV
Notes
TX
Tis
T1a
T1b
T2a
T2b
T1a
T1b
T2a
T2b
T3
T1a
T1b
T2a
T2b
T3
T3
T4
T4
T1a
T1b
T2a
T2b
T3
T4
T4
Any T
Any T
N0
N0
N0
N0
N0
N0
N1
N1
N1
N1
N0
N2
N2
N2
N2
N1
N2
N0
N1
N3
N3
N3
N3
N3
N2
N3
Any N
Any N
M0
M0
M0
M0
M0
M0
M0
M0
M0
M0
M0
M0
M0
M0
M0
M0
M0
M0
M0
M0
M0
M0
M0
M0
M0
M0
M1a
M1b
Financial support for AJCC 7th Edition Staging Posters
provided by the American Cancer Society
Copyright 2009 American Joint Committee on Cancer
•
invasive component limited to the bronchial wall, which may extend
proximally to the main bronchus, is also classified as T1a.
2 Most pleural (and pericardial) effusions with lung cancer are due to tumor.
In a few patients, however, multiple cytopathologic examinations of pleural
(pericardial) fluid are negative for tumor, and the fluid is nonbloody and is
not an exudate. Where these elements and clinical judgment dictate that
the effusion is not related to the tumor, the effusion should be excluded
as a staging element and the patient should be classified as M0.
Printed with permission from the AJCC.
1 The uncommon superficial spreading tumor of any size with its
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A m e r i c a n
J o i n t
C o m m i t t e e
o n
C a n c e r
Lung Cancer Staging
7t h E D I T I O N
Regional Lymph Nodes (N)
(© Memorial Sloan-Kettering
Cancer Center, 2009.)
Financial support for AJCC 7th Edition Staging Posters
provided by the American Cancer Society
•
The IASLC lymph node map shown
with the proposed amalgamation
of lymph into zones.
Copyright 2009 American Joint Committee on Cancer
ILLUSTRATION
Printed with permission from the AJCC.
NX Regional lymph nodes
cannot be assessed
N0 No regional lymph
node metastases
N1 Metastasis in ipsilateral
peribronchial and/or
ipsilateral hilar lymph nodes
and intrapulmonary nodes,
including involvement
by direct extension
N2 Metastasis in ipsilateral
mediastinal and/or
subcarinal lymph node(s)
N3 Metastasis in contralateral
mediastinal, contralateral
hilar, ipsilateral or
contralateral scalene, or
supraclavicular lymph node(s)
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